Intermediate Beis Medrash

<% Function SendNotification_email (firstname, hebrewname, lastname, birthdate , age, placebirth, arrivalDateIsrael, departureDateIsrael, permAddressAbroad, homephone, email, citizenship, passportnum, socialsecuritynum, mothersname , fathersname, jewish, notjewish, fathersoccupation, mothersoccupation, married, divorced, other, yearseducation, schoolsattended, VirtuallyNone, JewishDaySchool, YeshivaHighSchool, SundaySchoolpre13, SundaySchoolpost13 , Reform, Conservative, Orthodox, Unaffiliated, RecentlyObservant, memberjewishorg, beeninIsrael, birthright, aishprogs, whichaishprogs, hearprogram, takingmedication, prevtakingmedication, elabtakingmedication, lifepriorities, submit1 ) 'Set up mailing object Dim Mailer, body set Mailer=server.createobject("SMTPsvg.Mailer") Mailer.RemoteHost = const_Mailer_remoteHost Mailer.FromName = "" Mailer.FromAddress = "delete@aish.com" Mailer.Subject = "Application form for Intermediate Beis Medrash Program" 'Mailer.AddRecipient "","ljacobowitz@aish.com" Mailer.AddRecipient "","sgoldberg@aish.com" Mailer.AddRecipient "","drabinowitz2@gmail.com" 'Response.Write("elgraduate: " & elgraduate) ' Response.Write("
highgraduate: "& highgraduate) ' Response.Write("Position and/or honors attained in the Organization:"&posorg) 'for debug 'Mailer.AddCC "","csorscher@aish.com" Mailer.ContentType = "text/html" body = "" & vbCrLf & _ "

" & _ "

" & vbCrLf & _ "

First Name (please include middle name): "&firstname&"

" & _ "

Hebrew Name (please include middle name): " & hebrewname & "

" & _ "

Last Name: "&lastname&"

" & _ "

Date of Birth:"&birthdate&"

" & _ "

Age: "&age&"

" & _ "

Place of Birth"&placebirth&"

" & _ "

Anticipated date of Arrival in Israel:"&arrivalDateIsrael&"

" & _ "

Anticipated date of departure:"&departureDateIsrael&"

" & _ "

Permanent Address Abroad:"&permAddressAbroad&"

" & _ "

Phone Number:"&homephone&"

" & _ "

email:"&email&"

" & _ "

Citizenship:"&citizenship&"

" & _ "

Passport Number:"&passportnum&"

" & _ "

Social Security No."&socialsecuritynum&"

" & _ "

Mothers Full Name:"&mothersname&"

" & _ "

Fathers Full Name:"&fathersname&"

" & _ "
Was your mother born Jewish?
" 'response.write "
Line 49:" & body if jewish="yes" then body = body &"Yes, mother born Jewish
" else body = body &"No, mother not born Jewish
" end if body = body & "
If not, please give details (i.e. converted, etc.

" & _ "

" & _ "

Father's Occupation"&fathersoccupation&"

" & _ "

Mother's Occupation"&mothersoccupation&"

" & _ "
Parents Marital Status:
" if married="married" then body = body & "married
" else body = body & "married
" end if if divorced="divorced" then body = body & "divorced
" else body = body & "divorced
" end if if other="other" then body = body & "other
" else body = body & "other
" end if body = body & "

Years of education completed (starting with 1st grade):"&yearseducation&"

" & _ "
List all post-high / secondary schools you have attended: (School, Major, Dates, Gradutated?, Honors?)

" & _ "

" & _ "
What Jewish Education have you had?
" body = body & "

" 'if VirtuallyNone="VirtuallyNone" then 'body = body & "VirtuallyNone
" 'else 'body = body & "VirtuallyNone
" 'end if 'if JewishDaySchool="JewishDaySchool" then ' body = body & "JewishDaySchool
" 'else 'body = body & "JewishDaySchool
" 'end if 'if YeshivaHighSchool="YeshivaHighSchool" then 'body = body & "YeshivaHighSchool
" 'else 'body = body & "YeshivaHighSchool
" 'end if 'if SundaySchoolpre13="SundaySchoolpre13" then 'body = body & "SundaySchoolpre13
" 'else 'body = body & "SundaySchoolpre13
" 'end if 'if SundaySchoolpost13="SundaySchoolpost13" then 'body = body & "SundaySchoolpost13
" 'else 'body = body & "SundaySchoolpost13
" 'end if body = body & "
Your Jewish Orientation:
" if Reform="Reform" then body = body & "Reform
" else body = body & "Reform
" end if if Conservative="Conservative" then body = body & "Conservative
" else body = body & "Conservative
" end if if Orthodox="Orthodox" then body = body & "Orthodox
" else body = body & "Orthodox
" end if if Unaffiliated="Unaffiliated" then body = body & "Unaffiliated
" else body = body & "Unaffiliated
" end if if RecentlyObservant="RecentlyObservant" then body = body & "RecentlyObservantbr>" else body = body & "RecentlyObservant
" end if body = body & "
Have you been a member of Jewish organizations?
" if memberjewishorg="yes" then body = body &"Yes, member of jewish organization
" else body = body &"No, not member of jewish organization
" end if body = body &"
Have you ever been to Israel?
" if beeninIsrael="yes" then body = body &"Yes, I have been in Israel before
" else body = body &"No, I have not been in Israel before
" end if body = body & "
Have you ever been on Birthright?
" if beeninIsrael="yes" then body = body &"Yes, I have been on birthright before
" else body = body &"No, I have not been on birthright before
" end if body = body & "
Have you ever been on any Aish programs?
" if aishprogs="yes" then body = body &"Yes, I have been on an Aish program
" else body = body &"No, I have not been on an Aish program
" end if body = body & "
If Yes, what program and when?

" & _ "

" & _ "

How did you hear about the Intermediate Program?" & hearprogram & "

" & _ "
Are you currently taking any medication?
" if takingmedication="yes" then body = body &"Yes, I am taking medication
" else body = body &"No, I am not taking medication
" end if body = body & "
Have you previously taken any medication?
" if prevtakingmedication="yes" then body = body &"Yes
" else body = body &"No
" end if body = body & "

If Yes, please elaborate:"&elabtakingmedication&"

" & _ "
My 4 Life Priorities are:

" & _ "

" & _ "

" Mailer.bodyText = body if Mailer.SendMail then SendNotification_email = "" else dim error error = Mailer.Response if error = "" then error = "Unknown" SendNotification_email = error end if End Function %>

Educational Highlights

FAQ'S

Testimonials & News

Apply Now

<% 'response.write "
submitBtn:" & request("firstname") if Request.Form("submitBtn") <> "" then Dim jewisheducation, firstname, hebrewname, lastname, birthdate , age, placebirth, arrivalDateIsrael, departureDateIsrael, permAddressAbroad, homephone, email, citizenship, passportnum, socialsecuritynum, mothersname , fathersname, jewish, notjewish, fathersoccupation, mothersoccupation, married, divorced, other, yearseducation, schoolsattended, VirtuallyNone, JewishDaySchool, YeshivaHighSchool, SundaySchoolpre13, SundaySchoolpost13 , Reform, Conservative, Orthodox, Unaffiliated, RecentlyObservant, memberjewishorg, beeninIsrael, birthright, aishprogs, whichaishprogs, hearprogram, takingmedication, prevtakingmedication, elabtakingmedication, lifepriorities, submit1 firstname = quoteReplace(Request.Form("firstname")) hebrewname = quoteReplace(Request.Form("hebrewname")) lastname = quoteReplace(Request.Form("lastname")) birthdate = quoteReplace(Request.Form("birthdate")) age = quoteReplace(Request.Form("age")) placebirth = quoteReplace(Request.Form("placebirth")) arrivalDateIsrael = quoteReplace(Request.Form("arrivalDateIsrael")) departureDateIsrael = quoteReplace(Request.Form("departureDateIsrael")) permAddressAbroad = quoteReplace(Request.Form("permAddressAbroad")) homephone = quoteReplace(Request.Form("homephone")) email = quoteReplace(Request.Form("email")) citizenship = quoteReplace(Request.Form("citizenship")) passportnum = quoteReplace(Request.Form("passportnum")) socialsecuritynum = quoteReplace(Request.Form("socialsecuritynum")) mothersname = quoteReplace(Request.Form("mothersname")) fathersname = quoteReplace(Request.Form("fathersname")) jewish = quoteReplace(Request.Form("jewish")) notJewish = quoteReplace(Request.form("notJewish")) fathersoccupation = quoteReplace(Request.Form("fathersoccupation")) mothersoccupation = quoteReplace(Request.Form("mothersoccupation")) married = quoteReplace(Request.Form("married")) divorced = quoteReplace(Request.Form("divorced")) other = quoteReplace(Request.Form("other")) yearseducation = quoteReplace(Request.Form("yearseducation")) schoolsattended = quoteReplace(Request.Form("schoolsattended")) jewisheducation = quoteReplace(Request.Form("jewisheducation")) 'VirtuallyNone = quoteReplace(Request.Form("VirtuallyNone")) 'JewishDaySchool = quoteReplace(Request.Form("JewishDaySchool")) 'YeshivaHighSchool = quoteReplace(Request.Form("YeshivaHighSchool")) 'SundaySchoolpre13 = quoteReplace(Request.Form("SundaySchoolpre13")) 'SundaySchoolpost13 = quoteReplace(Request.Form("SundaySchoolpost13")) Reform = quoteReplace(Request.Form("Reform")) Conservative = quoteReplace(Request.Form("Conservative")) Orthodox = quoteReplace(Request.Form("Orthodox")) Unaffiliated = quoteReplace(Request.Form("Unaffiliated")) RecentlyObservant = quoteReplace(Request.Form("RecentlyObservant")) memberjewishorg = quoteReplace(Request.Form("memberjewishorg")) beeninIsrael = quoteReplace(Request.Form("beeninIsrael")) birthright = quoteReplace(Request.Form("birthright")) aishprogs = quoteReplace(Request.Form("aishprogs")) whichaishprogs = quoteReplace(Request.Form("whichaishprogs")) hearprogram = quoteReplace(Request.Form("hearprogram")) takingmedication = quoteReplace(Request.Form("takingmedication")) prevtakingmedication = quoteReplace(Request.Form("prevtakingmedication")) elabtakingmedication = quoteReplace(Request.Form("elabtakingmedication")) lifepriorities = quoteReplace(Request.Form("lifepriorities")) submit1 = quoteReplace(Request.Form("submit1")) %>

Thank You!
Your application was submitted.

Back to Aish.com

<% SendNotification_email firstname, hebrewname, lastname, birthdate , age, placebirth, arrivalDateIsrael, departureDateIsrael, permAddressAbroad, homephone, email, citizenship, passportnum, socialsecuritynum, mothersname , fathersname, jewish, notjewish, fathersoccupation, mothersoccupation, married, divorced, other, yearseducation, schoolsattended, VirtuallyNone, JewishDaySchool, YeshivaHighSchool, SundaySchoolpre13, SundaySchoolpost13 , Reform, Conservative, Orthodox, Unaffiliated, RecentlyObservant, memberjewishorg, beeninIsrael, birthright, aishprogs, whichaishprogs, hearprogram, takingmedication, prevtakingmedication, elabtakingmedication, lifepriorities, submit1 %> <%else%>

Confidentiality will be maintained for all personal information. Reporting inaccurate informtion on the application is grounds for disqualification and/or dismissal from the program.

First Name (please include middle name):

Hebrew Name:

Last Name:

Date of Birth: Age: Place of Birth:

Anticipated date of Arrival in Israel:

Anticipated date of departure:

Permanent Address Abroad:

Phone Number:

email:

Citizenship:

Passport Number:

Social Security No.

Mothers Full Name:

Fathers Full Name:

Was your mother born Jewish? yes no

If not, please give details (i.e. converted, etc.):

Father's Occupation

Mother's Occupation

Parents Marital Status: Married Divorced Other

Years of education completed (starting with 1st grade):

List all post-high / secondary schools you have attended: (School, Major, Dates, Gradutated?, Honors?)

Please describe your Jewish Education:

Your Jewish Orientation:
Reform Conservative Orthodox
Unaffiliated RecentlyObservant

Have you been a member of Jewish organizations? yes no

Names of Jewish Organizations:

Have you ever been to Israel? yes no

Have you ever been on Birthright? yes no

Have you ever been on any Aish programs? yes no

If Yes, what program and when?

How did you hear about the Intermediate Program?

Are you currently taking any medication? yes no

Have you previously taken any medication? yes no

If Yes, please elaborate:

My 4 Life Priorities are:

<%end if%>